Archive for November, 2017

“Once you made it inconvenient, I finally took steps to quit.”
– Former smoker, employee at Kaiser Permanente, 1980s.

Medical professional at Kaiser Permanente smoking a pipe and inspecting an X-ray, circa 1960

It wasn’t that long ago that cigarettes were an accepted part of the cultural landscape. It’s well-known that tobacco companies used to promote endorsements from physicians (although none from Permanente Medical Group doctors), and smoking in hospitals was typical, Kaiser Permanente facilities included.

A 1960s brochure from the Kaiser Permanente hospital in Fontana, Calif., cautioned patients that “Bedding can burn. Be careful with cigarettes and matches.” Staff housekeepers in many offices complained that one of their most common problems was fires in waste cans, because people would dump cigarette butts that weren’t completely put out. As medical evidence about tobacco’s harm piled up, however, it became clear that the smoking habit should not be part of the environment in health care facilities.

Kaiser Permanente first drove smoking out of its facilities in the 1980s. At first, the offices were smoke-free, then whole buildings. On January 1, 1987, a no-smoking policy went into effect in all Kaiser Permanente facilities throughout the Northwest Region. But people still went outside to smoke.

Anxious prospective fathers’ ashtray, “Dream Hospital” newsreel, 1953

California passed AB-13 prohibiting smoking in places of employment in 1997. On January 1, 2000, Southern California Kaiser Permanente banned smoking anywhere on campus property (including outdoor areas like parking lots, which were not included in prior local or state laws) making it the first major health care organization in the country to adopt such a sweeping policy.

There’s good evidence that the harder you make it for people to smoke, the more likely they are to quit.

One example comes from a Kaiser Permanente office building in the Portland area in the mid-1980s. A designated smoking shelter had been set up outside of an office building to keep smokers out the rain. But to make a point, a large crane was brought in and removed the structure for a photo opportunity. They unbolted it and lifted it off, a clear message that a haven for smokers was really gone, and they were not going to be able to light up there any longer.

Grudgingly, the smokers moved out to the curbs. One employee commented, “You know, I might have still been smoking, but once you made it inconvenient, I finally took steps to quit. What am I doing walking out in the rain to do this, this is ridiculous.”

Current practices to discourage smoking, beyond signage, include features at facilities that encourage healthy activities such as walking paths and outdoor exercise stations.

Now, smoking cessation has new targets – for example, dealing with e-cigarettes and vaping – but the goal remains the same. E.W. Emanuel, MD, of Mid-Atlantic Permanente Medical Group, sums it up well in his March 2017 blog that these new vehicles for tobacco delivery are still considered harmful to adolescents’ health. E-cigarettes contain nicotine and other potentially toxic chemicals, and teens who use them may be more likely to start smoking tobacco. Kaiser Permanente offers advice and programs for those wishing to break the tobacco habit.

During World War II, Henry J. Kaiser was a major producer of America’s “arsenal of democracy.” The Kaiser Richmond shipyards launched 747 ships; the yards in the Portland, Ore., area produced 743. Kaiser built cargo ships, tankers, fighting ships, and airplanes. Biographer Mark S. Foster dubbed him a “patriot in pinstripes.”

But Kaiser was no hawk. His eye was always on the human impact of the war, and his vision was focused on postwar reconstruction. He expressed these themes in a speech he gave in December, 1943:

Ironical as it must appear, the war has taught us to employ our vast resources and to multiply them a million-fold by power and the machine. The war has taught us how to train men and women quickly for new trades so that the labor, which is displaced by the machine can be quickly adapted to new techniques. In the dread circumstances of war, we have brought employment to the peak, and efficiency to an all-time high…[but] If we rebuild a world of monopoly and special privilege, we will taste a defeat as bitter as a victory for the Axis powers.

His employment record of 190,000 home front workers was unequalled, embracing the most diverse workforce to date in American history. While it’s true that as the war progressed, Kaiser had no choice but to hire workers beyond the standard industrial pool, he also did so without hesitation. He’d managed a diverse workforce in his construction business (such as while roadbuilding in Cuba in the 1920s) and learned how to adjust the work process to fit those who were doing it. His personal philosophy was to encourage the full development of all people.

Real Heroes comic, published by The Parents Magazine Press, 1943. Henry Kaiser is honored, along with Admiral William “Bull” Halsey and General Brehon Somervell.

He pushed back as much as he could against the unions that resisted change (most notoriously, the shipyard Boilermakers Union initially refused to hire women and blacks as equals to white workers), and went to great lengths to “accommodate” the needs of the new workforce – child care centers, special medical education programs, ability-based job placement, affordable health care – all things that he believed were of value to the postwar society as well.

As Allied victory began to appear certain, he redoubled his plans for the next phase of history. His October 17, 1944, speech “Jobs for All” in New York eloquently described his views:

On this one fact, there is unanimous agreement: every man in the American Forces has the right to come home not only to a job, but to peace. Anything less would be a denial of the true American way of life. Peace means so much more than a cessation of hostilities! Peace is a state of mind. It is based on the sense of security…Often I am classified as a dreamer, particularly when I talk about health insurance. To live abundantly and take part in a productive economy, our people must have health.